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1.
Jawad T. Ali Mitchell J. Daley Nina Vadiei Zachary Enright Joseph Nguyen Sadia Ali Jayson D. Aydelotte Pedro G. Teixeira Thomas B. Coopwood Carlos VR. Brown 《The American journal of emergency medicine》2017,35(4):632-636
Purpose
Thromboelastography (TEG) has been recommended to characterize post-traumatic coagulopathy, yet no study has evaluated the impact of pre-injury anticoagulation (AC) on TEG variables. We hypothesized patients on pre-injury AC have a greater incidence of coagulopathy on TEG compared to those without AC.Methods
This retrospective chart review evaluated all trauma patients admitted to an urban, level one trauma center from February 2011 to September 2014 who received a TEG within the first 24 h. Patients were classified as receiving pre-injury AC or no AC if their documented medications prior to admission included warfarin, dabigatran, or anti-Xa (aXa) inhibitors (apixaban or rivaroxaban). The presence of coagulopathy on TEG or conventional assays was defined by exceeding local laboratory reference standards.Results
A total of 54 patients were included (AC, n = 27 [warfarin n = 13, dabigatran n = 6, aXa inhibitor n = 8] vs. no AC, n = 27). Baseline characteristics were similar between groups, including age (72 ± 13 years vs. 72 ± 15; p = 0.85), male gender (70% vs. 74%; p = 0.76) and blunt mechanism of injury (100% vs. 100%; p = 1). There was no difference in the number of patients determined to have coagulopathy on TEG (no AC 11% vs. AC 15%; p = 0.99). Conventional tests, including the international normalized ratio (INR) and activated partial thromboplastin time (aPTT), identified coagulopathy in a high proportion of anti-coagulated patients (no AC 22% vs. AC 85%; p < 0.01).Conclusion
TEG has limited clinical utility to evaluate the presence of pre-injury AC. Traditional markers of drug induced coagulopathy should guide reversal decisions. 相似文献2.
Suprat Saely Wilson Gregory M. Kwiatkowski Scott R. Millis John D. Purakal Arushi P. Mahajan Phillip D. Levy 《The American journal of emergency medicine》2017,35(1):126-131
Objectives
The purpose of this study was to compare health care resource utilization among patients who were given intravenous nitroglycerin for acute heart failure (AHF) in the emergency department (ED) by intermittent bolus, continuous infusion, or a combination of both.Methods
We retrospectively identified 395 patients that received nitroglycerin therapy in the ED for the treatment of AHF over a 5-year period. Patients that received intermittent bolus (n = 124) were compared with continuous infusion therapy (n = 182) and combination therapy of bolus and infusion (n = 89). The primary outcomes were the frequency of intensive care unit (ICU) admission and hospital length of stay (LOS).Results
On unadjusted analysis, rates of ICU admission were significantly lower in the bolus vs infusion and combination groups (48.4% vs 68.7% vs 83%, respectively; P < .0001) and median LOS (interquartile range) was shorter (3.7 [2.5-6.2 days]) compared with infusion (4.7 [2.9-7.1 days]) and combination (5.0 [2.9-6.7 days]) groups; P = .02. On adjusted regression models, the strong association between bolus nitroglycerin and reduced ICU admission rate remained, and hospital LOS was 1.9 days shorter compared with infusion therapy alone. Use of intubation (bolus [8.9%] vs infusion [8.8%] vs combination [16.9%]; P = .096) and bilevel positive airway pressure (bolus [26.6%] vs infusion [20.3%] vs combination [29.2%]; P = .21) were similar as was the incidence of hypotension, myocardial injury, and worsening renal function.Conclusions
In ED patients with AHF, intravenous nitroglycerin by intermittent bolus was associated with a lower ICU admission rate and a shorter hospital LOS compared with continuous infusion. 相似文献3.
Background
Paraphimosis is an acute urologic emergency requiring urgent manual reduction, frequently necessitating procedural sedation (PS) in the pediatric population. The present study sought to compare outcomes among pediatric patients undergoing paraphimosis reduction using a novel topical anesthetic (TA) technique versus PS.Methods
We performed a retrospective analysis of all patients < 18 years old, presenting to a tertiary pediatric ED requiring analgesia for paraphimosis reduction between October 2013 and September 2016. The primary outcome was reduction first attempt success; secondary outcomes included Emergency Department length of stay (ED LOS), adverse events and return visits. Dichotomous outcomes were analyzed by Chi-square testing and multivariate linear regression was used to compare continuous variables.Results
Forty-six patients were included; 35 underwent reduction using TA, 11 by PS. Patient age and duration of paraphimosis at ED presentation did not differ between groups. There was no difference in first attempt success between TA (32/35, 91.4%) and PS groups (9/11, 81.8%; p = 0.37). Mean ED LOS was 209 min shorter for TA patients (148 min vs. 357 min, p = 0.001) and remained significantly shorter after controlling for age and duration of paraphimosis (adjusted mean difference ?198 min, p = 0.003). There were no return visits or major adverse events in either group, however, among successful reduction attempts, PS patients more frequently experienced minor adverse events (7/9 vs. 0/32, p < 0.001).Conclusions
Paraphimosis reduction using TA was safe and effective. Compared to PS, TA was associated with a reduced ED LOS and fewer adverse events. TA could potentially allow more timely reduction with improved patient experience and resource utilization. 相似文献4.
Background & objectives
A previous review of transfusion practices in our institution between 1998 and 2008 showed a trend of high ratios of red cells (RC) to plasma (FFP) and platelets to RC towards the later years of review period. The aim of the study was to further evaluate transfusion practices in the form of blood product usage and outcomes following massive transfusion (MT)Methods
All adult patients with critical bleeding who received a MT (defined as ≥10 units of RC in 24 h) in 2008 and between January 2010 and December 2014 were identified. Blood and blood products transfused, in-hospital mortality, 24 h and 90-day mortality were analysed for the period 2010–2014. Blood and blood product usage, massive transfusion protocol (MTP) activation and use of ROTEM between 2008 and 2014 were compared.Results
A total of 190 MT including surgical (52.1%), gastro-intestinal bleeding (25.3%), trauma (11.6%) and obstetric haemorrhage (5.8%) episodes were identified between 2010 and 2014. The overall in-hospital mortality was 26.7% with a significant difference in 24 h (p = 0.04) and 90-day mortality (p = 0.02) between diagnostic groups. Comparing 2008 (n = 33) and 2014 (n = 23), there was no significant difference in median RC, FFP and platelet units, cryoprecipitate doses and RC:FFP ratio; however there was an increase in number of patients who used cryoprecipitate (54.5% vs 87%, p = 0.01).Conclusion
Aligned with haemostatic resuscitation, the trend continues in the form of increased use of plasma and higher RC:FFP transfusion ratios including an increase in number of patients receiving cryoprecipitate. 相似文献5.
Mauro Giordano Tiziana Ciarambino Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Luca Rinaldi Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(5):749-752
Study objective
We investigated seasonal prevalence of hyponatremia in the emergency department (ED).Design
A cross-sectional study using clinical chart review.Setting
University Hospital ED, with approximately 28 000 patient visits a year.Type of participants
We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64 years old and the elderly group consisting of 5227 patients aged over 65 years presenting to the ED between January 1st, 2014 and December 31st, 2015.Intervention
Emergency patients were evaluated for the presence of hyponatremia by clinical chart review.Measurements and main results
Hyponatremia was defined as a serum sodium level < 135 mmol/l. Mean monthly prevalence of hyponatremia was of 3.74 ± 0.5% in the adult group and it was significantly increased to 10.3 ± 0.7% in the elderly group (p < 0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14 ± 0.2% in adult and markedly increased to 12.52 ± 0.7% (zenith) in elderly patients (p < 0.01 vs adult group; p < 0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p < 0.05).Conclusion
We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly. 相似文献6.
Lucas Oliveira J. e Silva M. Fernanda Bellolio Elisa M. Smith David J. Daniels Christine M. Lohse Ronna L. Campbell 《The American journal of emergency medicine》2017,35(10):1485-1489
Background
Motor vehicle–related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States.Objectives
To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED).Methods
We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015. Electronic health records were reviewed and data extracted using a standardized review process.Results
A total of 145 motocross-related ED visits (143 unique patients) were included. Overall, 95.2% of patients were men with a median age of 25 years. Sixty-seven visits (46.2%) were associated with head or spine injuries. Forty-three visits (29.7%) were associated with head injuries, and 46 (31.7%) were associated with spine injuries. Among the 43 head injuries, 36 (83.7%) were concussions. Seven visits (16.3%) were associated with at least 1 head abnormality identified by computed tomography, including skull fracture (n = 2), subdural hematoma (n = 1), subarachnoid hemorrhage (n = 4), intraparenchymal hemorrhage (n = 3), and diffuse axonal injury (n = 3). Among the 46 spine injuries, 32 (69.6%) were acute spinal fractures. Seven patients (4.9%) had clinically significant and persistent neurologic injuries. One patient (0.7%) died, and 3 patients had severe TBIs.Conclusion
Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%. 相似文献7.
Matthew J. Binks Rhys S. Holyoak Thomas M. Melhuish Ruan Vlok Elyse Bond Leigh D. White 《The American journal of emergency medicine》2017,35(10):1542-1546
Background
Hypoxemia increases the risk of intubation markedly. Such concerns are multiplied in the emergency department (ED) and during retrieval where patients may be unstable, preparation or preoxygenation time limited and the environment uncontrolled. Apneic oxygenation is a promising means of preventing hypoxemia in this setting.Aim
To test the hypothesis that apnoeic oxygenation reduces the incidence of hypoxemia during endotracheal intubation in the ED and during retrieval.Methods
We undertook a systematic review of six databases for all relevant studies published up to November 2016. Included studies evaluated apneic oxygenation during intubation in the ED and during retrieval. There were no exemptions based on study design. All studies were assessed for level of evidence and risk of bias. The Review Manager 5.3 software was used to perform meta-analysis of the pooled data.Results
Six trials and a total 1822 cases were included for analysis. The study found a significant reduction in the incidence of desaturation (RR = 0.76, p = 0.002) and critical desaturation (RR = 0.51, p = 0.01) when apneic oxygenation was implemented. There was also a significant improvement in first pass intubation success rate (RR = 1.09, p = 0.004).Conclusion
Apneic oxygenation may reduce patient hypoxemia during intubation performed in the ED and during retrieval. It also improves intubation first-pass success rate in this setting. 相似文献8.
Samantha Dankoff Patricia Li Adam J. Shapiro Terry Varshney Alexander S. Dubrovsky 《The American journal of emergency medicine》2017,35(4):615-622
Objectives
Primary objective was to characterize lung ultrasound findings in children with asthma presenting with respiratory distress to the emergency department (ED). Secondary objectives included correlating these findings with patients' clinical course in the ED.Methods
Eligible patients 2–17 years of age, underwent a lung ultrasound by the study sonographer between November 2014 to December 2015. Positive lung ultrasound was defined as the presence of ≥ 1 of the following findings: ≥ 3 B-lines per intercostal space, consolidation and/or pleural abnormalities. The treating physician remained blinded to ultrasound findings; clinical course was extracted from the medical chart.Results
A total of sixty patients were enrolled in this study. Lung ultrasound was positive in 45% (27/60) of patients: B-line pattern in 38%, consolidation in 30% and pleural line abnormalities in 12%. A positive lung ultrasound correlated with increased utilization of antibiotics (26% vs 0%, p = 0.03), prolonged ED length of stay (30% vs. 9%, p = 0.04) and admission rate (30% vs 0%, p = 0.03). Inter-rater agreement between novice and expert sonographers was excellent with a kappa of 0.92 (95% CI: 0.84–1.00).Conclusions
This study characterized lung ultrasound findings in pediatric patients presenting with acute asthma exacerbations; nearly half of whom had a positive lung ultrasound. Positive lung ultrasounds were associated with increased ED and hospital resource utilization. Future prospective studies are needed to determine the utility and reliability of this tool in clinical practice. 相似文献9.
Kristin Berona Amin Abdi Michael Menchine Tom Mailhot Tarina Kang Dina Seif Mikaela Chilstrom 《The American journal of emergency medicine》2017,35(2):240-244
Purpose
The objectives of this study were to evaluate emergency medicine resident-performed ultrasound for diagnosis of effusions, compare the success of a landmark-guided (LM) approach with an ultrasound-guided (US) technique for hip, ankle and wrist arthrocentesis, and compare change in provider confidence with LM and US arthrocentesis.Methods
After a brief video on LM and US arthrocentesis, residents were asked to identify artificially created effusions in the hip, ankle and wrist in a cadaver model and to perform US and LM arthrocentesis of the effusions. Outcomes included success of joint aspiration, time to aspiration, and number of attempts. Residents were surveyed regarding their confidence in identifying effusions with ultrasound and performing LM and US arthrocentesis.Results
Eighteen residents completed the study. Sensitivity of ultrasound for detecting joint effusion was 86% and specificity was 90%. Residents were successful with ultrasound in 96% of attempts and with landmark 89% of attempts (p = 0.257). Median number of attempts was 1 with ultrasound and 2 with landmarks (p = 0.12). Median time to success with ultrasound was 38 s and 51 s with landmarks (p = 0.23). After the session, confidence in both US and LM arthrocentesis improved significantly, however the post intervention confidence in US arthrocentesis was higher than LM (4.3 vs. 3.8, p < 0.001).Conclusions
EM residents were able to successfully identify joint effusions with ultrasound, however we were unable to detect significant differences in actual procedural success between the two modalities. Further studies are needed to define the role of ultrasound for arthrocentesis in the emergency department. 相似文献10.
Yuji Shono Tomohiko Akahoshi Satomi Mezuki Kenta Momii Noriyuki Kaku Jun Maki Kentaro Tokuda Tetsuro Ago Takanari Kitazono Yoshihiko Maehara 《The American journal of emergency medicine》2017,35(12):1836-1838
Background and purpose
Accurate diagnosis of acute aortic dissection (AAD) is sometimes difficult because of accompanying central nervous system (CNS) symptoms. The purpose of this study was to investigate the clinical characteristics of Type A AAD (TAAAD) with CNS symptoms.Methods
We retrospectively reviewed the medical records of 8403 patients ambulanced to our emergency and critical care center between April 2009 and May 2014.Results
We identified 59 TAAAD patients for the analysis (mean age, 67.3 ± 10.5 years; 37 (62.0%) male). Eleven patients (18.6%) presented CNS symptoms at the onset of TAAAD, and these patients complained less frequently of typical chest and back pain than those without CNS symptoms (p < 0.0001). Initial systolic and diastolic blood pressure were lower (p = 0.003, and p = 0.049, respectively) and involvement of the supra-aortic artery was more frequent in patients with CNS symptoms (p < 0.0001).Conclusion
Because CNS symptom can mask chest and back pain caused by TAAAD, physicians should always consider the possibility of TAAAD in patients with CNS symptoms in emergency medicine settings. 相似文献11.
C. Kajetanek R. Rousseau K. Makridis M. Sanchez C. Delin P. Djian 《Journal de Traumatologie du Sport》2017,34(1):37-43
Background
Anterior cruciate ligament (ACL) rupture is a common pathology. Risk factors include significant tibial slope. The purpose of this study was to determine whether this relationship is observed in recurrent rupture of the ACL. Our hypothesis was that significant tibial slope is a risk factor for rupture.Material and methods
We reviewed at two years follow-up 386 ligamentoplasties performed from 2000 to 2012. There were 20 recurrent ruptures in this series (5.2%). These patients, mean age 21 ± 6.3 years, underwent 3D EOS goniometry to measure the medial and lateral tibial slope (MTS and LTS, respectively). These same measures were made in a comparative group of controls that had ACL surgery without secondary rupture and seen at mean 33.4 (range 28–37) months follow-up.Results
Mean MTS was significantly lower in the recurrent rupture group (10.5 ± 3.3° vs. 12.8 ± 2.7°; P = 0.02). This led to asymmetrical tibial slope with a mean LTS in the recurrent rupture group greater than the mean MTS (delta = –0.52 vs. +0.83). The mean LTS was not significantly different between groups (11 ± 3.4° vs. 12 ± 3.4°; P = 0.30).Conclusion
This study demonstrated that asymmetrical tibial slope due to a MTS lower than the LTS can be a risk factor for recurrent rupture of the ACL.Case-control
Level III. 相似文献12.
Saee Byel Kang Kyung Su Kim Gil Joon Suh Woon Yong Kwon Kyoung Min You Min Ji Park Jung-In Ko Taegyun Kim 《The American journal of emergency medicine》2017,35(10):1457-1461
Background
The aim of this study was to investigate whether the 1-year survival rate of out-of-hospital cardiac arrest (OHCA) patients with malignancy was different from that of those without malignancy.Methods
All adult OHCA patients were retrospectively analyzed in a single institution for 6 years. The primary outcome was 1-year survival, and secondary outcomes were sustained return of spontaneous circulation (ROSC), survival to hospital admission, survival to discharge and discharge with a good neurological outcome (CPC 1 or 2). Kaplan-Meier survival analysis and Cox proportional hazard regression analysis were performed to test the effect of malignancy.Results
Among 341 OHCA patients, 59 patients had malignancy (17.3%). Sustained ROSC, survival to admission, survival to discharge and discharge with a good CPC were not different between the two groups. The 1-year survival rate was lower in patients with malignancy (1.7% vs 11.4%; P = 0.026). Kaplan-Meier survival analysis revealed that patients with malignancy had a significantly lower 1-year survival rate when including all patients (n = 341; P = 0.028), patients with survival to admission (n = 172, P = 0.002), patients with discharge CPC 1 or 2 (n = 18, P = 0.010) and patients with discharge CPC 3 or 4 (n = 57, P = 0.008). Malignancy was an independent risk factor for 1-year mortality in the Cox proportional hazard regression analysis performed in patients with survival to admission and survival to discharge.Conclusions
Although survival to admission, survival to discharge and discharge with a good CPC rate were not different, the 1-year survival rate was significantly lower in OHCA patients with malignancy than in those without malignancy. 相似文献13.
Rubén Navarro-Patón Miguel Freire-Tellado Ma del Pilar Pavón-Prieto Daniel Vázquez-López Miguel Neira-Pájaro Sergio Lorenzana-Bargueiras 《The American journal of emergency medicine》2017,35(4):569-573
Purpose
The aim of this study was to compare on manikin chest compressions only CPR performance carried out by untrained volunteers following Dispatcher assisted Cardiopulmonary Resuscitation (DACPR), and then by the same trained volunteers immediately after chest compressions only CPR course and 4 months after the CPR course.Method
38 university student volunteers with no previous experience in CPR took part in three on manikin chest compressions only CPR skill evaluations: first in a DACPR, then after chest compressions only CPR course (ACPRC) and lastly, four months after a CPR course (4MACPRC). Only 22 completed the whole process.Results
In DACPR 7.89% of participants carried out cardiac compressions outside the thorax. The mean average time from collapse to first compression was reduced in 4MACPRC (40.77 s), as compared to DACPR (144.54 s); p < 0.001).The following parameters were significantly better in 4MACPRC than in DACPR: Average compression depth (44.72 vs 25.22; p < 0.001), average compression rate (106.1 vs 87.90; p < 0.001), total number of compressions in 3 min (317 vs 245; p < 0.001), percentage of correct compressions (53.00% vs 4.72 %; p < 0.001) and percentage of correct hand positioning (95.40 vs 91.09; p < 0.001).Conclusions
Even though chest compressions only DACPR allows lay bystanders to be able to carry out cardiac compressions in 92.1% of cases, these were delivered later and were less efficient than chest compressions only CPR given by trained bystanders after a CPR course and four months after the course. 相似文献14.
Lauren T. Southerland Lauren Slattery Joseph A. Rosenthal Deborah Kegelmeyer Anne Kloos 《The American journal of emergency medicine》2017,35(2):329-332
Objectives
The American College of Emergency Physicians Geriatric Emergency Department (ED) Guidelines and the Center for Disease Control recommend that older adults be assessed for risk of falls. The standard ED assessment is a verbal query of fall risk factors, which may be inadequate. We hypothesized that the addition of a functional balance test endorsed by the Center for Disease Control Stop Elderly Accidents, Deaths, and Injuries Falls Prevention Guidelines, the 4-Stage Balance Test (4SBT), would improve the detection of patients at risk for falls.Methods
Prospective pilot study of a convenience sample of ambulatory adults 65 years and older in the ED. All participants received the standard nursing triage fall risk assessment. After patients were stabilized in their ED room, the 4SBT was administered.Results
The 58 participants had an average age of 74.1 years (range, 65-94), 40.0% were women, and 98% were community dwelling. Five (8.6%) presented to the ED for a fall-related chief complaint. The nursing triage screen identified 39.7% (n = 23) as at risk for falls, whereas the 4SBT identified 43% (n = 25). Combining triage questions with the 4SBT identified 60.3% (n = 35) as at high risk for falls, as compared with 39.7% (n = 23) with triage questions alone (P < .01). Ten (17%) of the patients at high risk by 4SBT and missed by triage questions were inpatients unaware that they were at risk for falls (new diagnoses).Conclusions
Incorporating a quick functional test of balance into the ED assessment for fall risk is feasible and significantly increases the detection of older adults at risk for falls. 相似文献15.
James R. Miner Brian E. Driver Johanna C. Moore Erik Faegerstrom Lauren Klein Matthew Prekker Jon B. Cole 《The American journal of emergency medicine》2017,35(10):1451-1456
Study objective
To compare the frequency of airway and respiratory adverse events leading to an intervention between moderate sedation using alfentanil or propofol.Methods
We performed a randomized clinical trial in which adults undergoing moderate sedation in the ED received either alfentanil or propofol. Our primary outcome was the frequency of airway and respiratory adverse events leading to an intervention. Other outcomes included sedation depth, efficacy, sedation time, patient satisfaction, pain, and satisfaction.Results
108 subjects completed the trial: 52 receiving alfentanil and 56 receiving propofol. Airway or respiratory adverse events leading to an intervention were similar between the two groups: 23% for alfentanil and 20% for propofol (p = 0.657). There were no serious adverse events in any group. Secondary outcomes were notably different in the rate of reported pain (48% for alfentanil, 13% for propofol) and recall (75% for alfentanil, 23% for propofol) and similar in the rate of satisfaction with the procedure (87% for alfentanil, 84% for propofol).Conclusion
We found a similar frequency of airway and respiratory adverse events leading to intervention between alfentanil and propofol used for moderate procedural sedation. Both agents appear safe for moderate procedural sedation. 相似文献16.
Keret Sandra Nahari Meital Merin Ofer Aharonson-Daniel Limor Goldberg Sara Adini Bruria 《The American journal of emergency medicine》2017,35(5):681-684
Background
Though hospitals' operational continuity is crucial, full institutional evacuation may at times be unavoidable. The study's objective was to establish criteria for discharge of patients during complete emergency evacuation and compare scope of patients suitable for discharge pre/post implementation of criteria.Basic procedures
Standards for patient discharge during an evacuation were developed based on literature and disaster managers. The standards were reviewed in a two-round Delphi process. All hospitals in Israel were requested to identify inpatients' that could be released home during institutional evacuation. Potential discharges were compared in 2013–2014, before and after formulation of discharge criteria.Main findings
Consensus exceeding 80% was obtained for four out of five criteria after two Delphi cycles. Average projected discharge rate before and after formulation of criteria was 34.2% and 42.9%, respectively (p < 0.001). Variance in potential dischargeable patients was 31-fold less in 2014 than in 2013 (MST = 8,452 versus MST = 264,366, respectively; p < 0.001). Differences were found between small, medium and large hospitals in mean rate of dischargeable patients: 52.1%, 41.5% and 42.2%, respectively (p = 0.001).Principle conclusions
The study's findings enable to forecast the extent of patients that may be released home during full emergency evacuation of a hospital; thereby facilitating preparedness of contingency plans. 相似文献17.
Thara Kumar Kari Sampsel Ian G. Stiell 《The American journal of emergency medicine》2017,35(12):1798-1803
Background/objectives
Due to perceived increased tolerability and compliance, and decreased cost, recent trends in practice are moving towards using fewer drugs for HIV post-exposure prophylaxis. However, there is limited literature to assess this is in the North American sexual assault victim population.Methods
This retrospective before-and-after cohort study compared patients seen at a sexual assault care facility before and after the introduction of two and three-drug post-exposure prophylaxis regimens. Our primary outcome was completion of the 28-day regimen. Secondary objectives included HIV seroconversion rates and patient reported side effects.Results
Six-hundred-thirty charts from a 2-year period were reviewed, and 429 met inclusion criteria. There was no difference in completion rates of post-exposure prophylaxis between the two cohorts (50.5% vs. 51.6%). However, there were fewer reported side effects (72.2% vs. 17.6%) in the later cohort. We subsequently compared all patients in either cohort who received four-drug therapy (N = 128) versus those who received two or three-drug regimens (N = 47). The two or three-drug regimen group had a higher completion rate (66.0% vs. 42.2%; p = 0.03), and a lower rate of reported side effects (19.1% vs. 53.9%), specifically for nausea (12.8% vs. 36.7%), constipation (0% vs. 7.9%), diarrhea (2.1% vs. 21.1%), mood changes (0% vs. 10.9%), headache (2.1% vs. 16.4%), and fatigue (6.4% vs. 26.6%). There were no HIV seroconversions in either group.Conclusion
Two and three-drug HIV post-exposure prophylaxis regimens are better tolerated by patients and associated with greater compliance than four-drug therapy, and could be considered in the sexual assault victim population. 相似文献18.
Guillaume Gantois Erika Parmentier-Decrucq Thibault Duburcq Raphaël Favory Daniel Mathieu Julien Poissy 《The American journal of emergency medicine》2017,35(11):1672-1676
Introduction
Patients surviving a self-attempted hanging have a total neurological recovery in 57–77% of cases at hospital discharge, but no long-term data are available.Methods
In this observational study, all patients hospitalized post-self-attempted hanging in the intensive care unit (ICU) in a 5-year period were included. Neurological evaluations at 6 and 12 months were performed according to Cerebral Performance Category (CPC) scores. Factors associated with neurological recovery were determined by comparing CPC2 + 3 + 4 (bad recovery) vs. CPC1 (good recovery).Results
Of 231 patients included, 104 (47%) were found to have cardiac arrest (CA). Ninety-five (41%) patients died in the ICU: 93 (89%) in the CA group and 2 (1.6%) in the group without CA. Neurological evaluations at 6 and 12 months were obtained in 97 of the 136 surviving patients. At 6 months, in the CA group (n = 9), the CPC score was 1 for 6 patients, 2 for 2, and 4 for 1 patient. In the group without CA (n = 88), 79 patients had normal neurological status at 6 months and 78 at 12 months. Among these patients, 96% returned home, 77% returned to work, 16 (18%) patients re-attempted suicide within the year. Risk factors of neurological sequelae at 6 months were a CA at the hanging site (P = 0.045), an elevated diastolic blood pressure (87 vs. 70 mm Hg; P = 0.04), a lower initial Glasgow score (4 vs. 5; P = 0.04), and an elevated blood glucose level (139 vs. 113 mg/dL; P < 0.001).Conclusion
Patients surviving a self-attempted hanging who did not have a CA had a good neurological outcome. The rate of suicidal recidivism is particularly important, which justifies joint work with psychiatrists. 相似文献19.
Neil Beri Nicholas A. Marston Lori B. Daniels Richard M. Nowak Donald Schreiber Christian Mueller Allan Jaffe Deborah B. Diercks Nicholas Wettersten Christopher DeFilippi W. Frank Peacock Alexander T. Limkakeng Inder Anand James McCord Judd E. Hollander Alan H.B. Wu Fred S. Apple John T. Nagurney Alan Maisel 《The American journal of emergency medicine》2017,35(2):274-280
Background
Copeptin is a marker of endogenous stress including early myocardial infarction(MI) and has value in early rule out of MI when used with cardiac troponin I(cTnI).Objectives
The goal of this study was to demonstrate that patients with a normal electrocardiogram and cTnI < 0.040 μg/l and copeptin < 14 pmol/l at presentation and after 2 h may be candidates for early discharge with outpatient follow-up potentially including stress testing.Methods
This study uses data from the CHOPIN trial which enrolled 2071 patients with acute chest pain. Of those, 475 patients with normal electrocardiogram and normal cTnI(< 0.040 μg/l) and copeptin < 14 pmol/l at presentation and after 2 h were considered “low risk” and selected for further analysis.Results
None of the 475 “low risk” patients were diagnosed with MI during the 180 day follow-up period (including presentation). The negative predictive value of this strategy was 100% (95% confidence interval(CI):99.2%–100.0%). Furthermore no one died during follow up. 287 (60.4%) patients in the low risk group were hospitalized. In the “low risk” group, the only difference in outcomes (MI, death, revascularization, cardiac rehospitalization) was those hospitalized underwent revascularization more often (6.3%[95%CI:3.8%–9.7%] versus 0.5%[95%CI:0.0%–2.9%], p = .002). The hospitalized patients were tested significantly more via stress testing or angiogram (68.6%[95%CI:62.9%–74.0%] vs 22.9%[95%CI:17.1%–29.6%], p < .001). Those tested had less cardiac rehospitalizations during follow-up (1.7% vs 5.1%, p = .040).Conclusions
In conclusion, patients with a normal electrocardiogram, troponin and copeptin at presentation and after 2 h are at low risk for MI and death over 180 days. These low risk patients may be candidates for early outpatient testing and cardiology follow-up thereby reducing hospitalization. 相似文献20.
Egarit Noulsri Surada Lerdwana Kulvara Kittisares Attakorn Palasuwan Duangdao Palasuwan 《Transfusion and apheresis science》2017,56(4):585-590